Hodgkin's disease with spinal cord compression. A case report and a review of the literature

Abstract

Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5% of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. A case report of a 46-year-old man who presented with signs and symptoms of spinal cord compression and was found to have an extradural mass in the cervical and thoracic spine is described. Biopsy revealed Hodgkin's disease. This case report represents a unique case of a patient with Hodgkin's disease presenting with epidural disease, with spinal cord compression as the only apparent site of initial clinical involvement. A review of the literature of patients with Hodgkin's disease presenting with spinal cord compression from 1970 to the present is presented. The patient, whom we report, received chemotherapy followed by external beam radiation therapy and achieved complete resolution of symptoms and a complete response by radiologic criteria. Based on a review of the literature, Hodgkin's disease involving the spinal epidural space is very responsive to radiation therapy and chemotherapy with a good prognosis for both functional recovery (86%), complete response (61%), and long term survival. Chemotherapy and/or radiation therapy is successful treatment for Hodgkin's disease presenting with spinal cord compression. For the rare patient who presents with spinal cord compression as the initial symptom of Hodgkin's disease, the therapeutic options include chemotherapy alone, radiation therapy alone, or combined modality therapy.